A New Jersey-based hospital has repurposed emergency department staff to improve efficiency.
An initiative launched in January has significantly improved efficiency at Cooperman Barnabas Medical Center's emergency department.
For patients, lengthy wait times are common at emergency rooms across the country. The result is a poor patient experience, with some patients choosing to leave emergency rooms to seek care at other facilities.
Since the efficiency initiative was launched, the emergency department at Cooperman Barnabas Medical Center has posted impressive wait time statistics:
- The average wait time from patient arrival to being placed in a room is under 10 minutes.
- The average time to talk to a healthcare provider is about 10 minutes.
- The median turnaround time for patients to be seen, treated, and discharged was 160 minutes during the most recent month for which data is available.
The front-end process at the Livingston, New Jersey hospital's emergency department moves patients quickly, says Maria Aponte, MPA, BSN, RN, administrative director of emergency services.
"As soon as someone comes in, they are greeted by a security guard, who finds out whether they are a patient or a visitor. If you are a patient, you are seen by the first nurse, who does not conduct triage. The nurse does a quick assessment by asking a couple of questions. Then the patient is quickly registered with five registration questions. A full registration is not done on the front-end, which cuts down on a lot of the time. Five questions get asked and the patient gets directly bedded to the back," she says.
Clinicians see patients as quickly as possible, says Eric Handler, DO, chairman of emergency medicine. "On the provider side, not too much has changed other than we are really happy to have the patient in the room and being able to see them there instead of having to bring that process up front."
Rooms are available in part because the hospital is working hard to make sure patients are not boarded in the emergency department after they are admitted, Aponte says. "One of the biggest factors in efficiency is patient boarding. In the past, we had patients waiting for a bed upstairs for three or four hours. We have made sure that we have good throughput throughout the hospital. That means, when a physician puts in an order to admit a patient, the patient is bedded in the hospital as quickly as possible. We want to move patients out of the emergency department so we can see other patients. Becoming more efficient in the emergency department is a hospital-wide initiative."
Similarly, the emergency department is getting timely service when tests are ordered for a patient, Handler says.
"We have been having a bi-weekly throughput committee meeting, where we get together with all of the stakeholders and hold everybody accountable in a collegial way. We have stakeholders such as laboratory, transport, logistics, and radiology, and we make sure everybody is on the same page and being as efficient as we can. … With the throughput committee meeting, we are making sure that radiology does X-rays right away, and CAT scans, ultrasounds, and lab tests are done right away. We are making sure that these other stakeholders are onboard with the new process. We look at the metrics, and we look at the times, and we see how we can improve. We make sure all of the stakeholders are making us more efficient."
An innovative aspect of the efficiency initiative is that the emergency department was able to improve without hiring more staff, Aponte says. "What we did was repurpose staff. Before, we were sending resources to the front such as a provider in triage and getting lab work on the front-end. We were able to become more efficient and bring patients directly into a room by repurposing staff. A provider who was seeing patients in the front was freed up to see patients at the bedside. The nurse who was doing the triage in the front became a floating triage nurse who can provide triage at the bedside and assist the primary nurse who is providing care."
The emergency department also has an efficient discharge process, Handler says. "Once we get the results of tests back, we can make the determination whether it is safe to discharge the patient home. Our goal from there is to get the patient out the door with their discharge instructions in less than 30 minutes."
Advice for other emergency departments
Teamwork is crucial to improve emergency department efficiency, Handler says. "Maria and I speak frequently throughout the day. We observe what is happening in the emergency department into the early evening to make sure things are going smoothly. There is a HIPAA-compliant text service called TigerConnect that we use with all of our stakeholders. If there is a delay in one area, we get a message out and the person responsible for that area—whether it is lab, radiology, transport, or logistics—does their best to rectify the problem. Without teamwork and an eye on the ball, things can fall apart quickly."
Emergency department teams need to care about efficiency and their patients, Aponte says. "You need to care about the initiatives that you are doing and care for the people doing the work. You also need to provide patient-centered care. When someone comes to the emergency room, it can be scary for them. They are very anxious when they arrive. You need to care about the efficiency model and care about what is right. We cared enough that we knew that our time numbers were not meeting our expectations."
Patient satisfaction can be a powerful motivator for emergency department staff when conducting efficiency initiatives, Handler says. "One of the things that got us the biggest buy-in and gave us momentum was when the staff saw how happy the patients were and how much easier the encounter became because the patient was not upset, frustrated, or disappointed. Patients get dissatisfied if they sit in a waiting room for hours before being seen. The encounter goes so much more smoothly when you have a happy patient in front of you instead of an angry one."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
When a patient enters Cooperman Barnabas Medical Center's emergency room, a nurse does a quick assessment by asking a couple of questions, then the patient is quickly registered with five registration questions.
The average wait time from patient arrival to being placed in a room is under 10 minutes.
The hospital's emergency department efficiency initiative requires cooperation to reduce emergency room boarding and conduct clinical testing quickly.